Looking to the future – a week meeting potential new collaborators for the MalDent Project

For the middle part of my visit to Malawi the weather was uncharacteristically cool, wet and windy – not at all the hot, dry season that would be anticipated for this time of year. Comments were made that I had brought Scottish weather to the Warm Heart of Africa! This change in the weather was compounded by multiple power cuts, one of which lasted for more than 24 hours. The solar powered lanterns that Ruthie normally used on the khonde in the evenings came in very handy for interior lighting.

On Tuesday 1st October Ruthie drove me to The Beehive Social Enterprise at Chilomoni. Many of my colleagues in the Scotland Malawi Partnership had praised this organisation on multiple occasions in discussion and I was grateful to Ruthie for making the introduction. There are many strands to the work of Beehive, but I was particularly keen to hear about their work in Early Child Development Centres (ECDCs) and schools.

Our visit was hosted by Limbani Njewa, the Community Services Manager, who introduced us to Hannah Kagona, the Outreach Manager. Limbani explained that the focus of their work is to support vulnerable people in the community, with an emphasis on family support. They have an extended schools team and provide education and support from ECDC (nursery) level through to tertiary education. Limbani’s teams collect data on the ECDCs and associated food programme. The food is provided by Seibo and prepared by local villagers through parent forums.

Following Limbani’s description of their activities, I spoke about our ambitions for child oral health improvement in Malawi, including our search for potential sites in ECDCs and schools to undertake feasibility studies. Limbani was very enthusiastic and encouraging in relation to a possible role for Beehive as we develop our plans, so there is tremendous scope here for collaboration.

On Wednesday 2nd October I spent the morning with the Blantyre District Health Management Team. Although he was away on other business, this meeting had been set up by Dr Gift Kawalazira, the District Health Officer.

The morning started with three summary presentations by postgraduate students. The first related to distribution of essential medicines in Limbe, an area in the Blantyre district …

… the second on ergonomic hazards in healthcare in Malawi …

… and the third on a PhD project on retinopathy in children with cerebral malaria …

There followed reports from the coordinators of six of the healthcare programmes operating in Blantyre District. The School Health & Nutrition Programme is led by Ennis Kaunda, who gave a very interesting presentation that is of direct relevance to the work we are planning around child oral health improvement interventions in schools:

We also heard from Chrissy Banda who heads up the Health Promotion Programme:

One of Chrissy’s slides was especially relevant to our ambitions to improve child oral health, citing that health education messaging, whilst important, is insufficient on its own to change behaviour:

My good friend Wisdom gave a brief presentation on oral health care for children:

Following the presentations from the leaders of the individual programmes already underway, I gave a short talk about the MalDent Project and our plans for the future. Once again, there were clear opportunities for collaboration moving forwards and I left the meeting feeling very encouraged.

One of the challenges facing any form of dentistry in public institutions in Malawi relates to ensuring a reliable pipeline of the required consumables such as local anaesthetic solution and filling materials. On Thursday 3rd October my friend and colleague Nelson Nyoloka, a Lecturer in Pharmacy at KUHeS, kindly arranged a meeting for Peter Chimimba and I at the Central Medical Stores Trust (CMST) offices and warehouse in Blantyre so that these supply issues could be discussed.

Mr Geoffrey Ngwira, the CMST Director of Pharmaceutical Operations and Mr Vincent Chilinda, the CMST Finance Manager, had both travelled from Lilongwe to join the meeting, for which we were extremely grateful. Later, we were also joined by Mr Godfrey Kadewere, Director of Health Technical Support Services at the Ministry of Health.

It was a very valuable morning. First, Mr Stewart Lichapa, the local CMST Manager, delivered a Powerpoint presentation that provided an overview of the CMST and its operations. The former Central Medical Stores, operating under the Ministry of Health, converted to its current structure through a Trust Deed in 2010 and the CMST became operational in 2012. Its function is to procure, warehouse and sell pharmaceuticals and equipment to public facilities and CHAM hospitals.

CMST has to estimate the volume of materials it procures based on projected Ministry of Health requirements, but is then reliant on public health facilities having sufficient funds to purchase those drugs and equipment. Unfortunately, public health facilities have limited funding, leading to significant financial challenges for CMST, including cash flow problems resulting from delayed payments by customers, potentially compounded by currency devaluations.

It was explained that availability of specific drugs responds to the Essential Health Package, which has resulted in creation of a Must Have List (MHL) of 405 items, from a catalogue of 5842 items. There are currently 10 dental items on the MHL, which we have been invited to review and amend as required. We have agreed to create a document that will define in more detail the list of commodities and volumes required to support both dental education and delivery of dental clinical services.

One of the final activities to satisfy requirements of the Scottish Government MalDent Project grant is to undertake an end of project evaluation. The advert to recruit a suitable consultant has now been lodged in the local press with expressions of interest due by 17th October. We look forward to this external evaluation of work to date, which may also provide some guidance for our future plans.

Blantyre Farmers’ Market is a local tradition that takes place on the first Saturday of every month, so one was scheduled for Saturday 5th October. Ruthie normally attends and she kindly invited me along too. At the end of a busy week it was good to take some time out and enjoy this new experience.

The event is a hub for promoting locally made products, including food, crafts and textiles. It aims to support the growth of local businesses and artisans.

Once parked, we entered the market. It was a vibrant event full of colour and the aroma of good food cooking.

I wandered around the market and purchased some locally made items from two of the stalls:

After perusing the stalls, I settled down to chat with some of the new friends I have made during my recent stay, thanks to introductions from Ruthie.

This short video gives a feel for the atmosphere at the event, enlivened by the music being played by the live band:

On the Sunday, I enjoyed lunch with my friend Nelson, who was about to leave for Lilongwe, where he would be teaching pharmacology to nursing students for the next week. We visited Sky Lounge Restaurant, an eatery that was new to me and which served up a very tasty lunch.

This had been an excellent week for making new contacts with whom we can collaborate as the MalDent Project moves into its next phase. Over the following week we would be joined by Leon Grobbelaar from John McAslan + Partners, a longstanding collaborator, when our attention would turn back to finalising the designs and gaining permissions for the new dental teaching facility / student hub on the Blantyre campus of KUHeS.